COVID-19 RAPID GUIDELINES

The purpose of guidelines is to provide recommendations to manage COVID-19 symptoms for the patients. These recommendations bring together existing national and international guidance and policies, the advice from specialists working in the NHS from across the UK. These include people with expertise and experience of treating patients for the specific health conditions covered by the guidance during the current COVID-19 pandemic.

These guidelines have been developed by NICE and are based on evidence and expert opinion and have been verified as far as possible. Let us start with the following:

1. Communicating with patients and minimising risk.

• Communicate with patients and support their mental wellbeing, signposting to charities and support groups, to help alleviate any anxiety and fear they may have about COVID-19.
• Minimise face-to-face contact by using electronic prescriptions rather than papers, offering telephonic or video consultations, prefer pick-up points for medicines in order to deliver medicines to the patients.

2. Treatment and care planning.

• Put treatment escalation plans in place because patients with COVID‑19 may deteriorate rapidly and need urgent hospital admission.
• Discuss the risks, benefits and possible likely outcomes of the treatment options with patients with COVID‑19, and their families and carers, so that they can express their preferences about their treatment and escalation plans. Must note that these discussions may need to take place remotely.

3. General advice for managing COVID-19 symptoms.

• While managing COVID-19 symptoms, one must take into account that not all patients will have COVID-19, the patient’s underlying health conditions, severity of the acute illness and if they are taking multiple medicines, older patients with chronic obstructive pulmonary disease (COPD), hypertension, diabetes and asthma, may have higher risk of deteriorating hence they require monitoring and intensive management including hospital admission.
• When managing key symptoms of COVID‑19 in the last hours and days of life, follow the relevant parts of NICE guideline on care of dying adults in the last days of life. This includes pharmacological interventions and anticipatory prescribing. Note that symptoms can change, and patients can deteriorate rapidly in a few hours or less.

4. Managing cough.

• Use simple measures first, including getting patients with cough to take honey (for patients aged over 1 year). If cough is distressing consider short term use of codeine linctus (15 mg/5 ml) or morphine sulphate oral solution (10 mg/5 ml).
• Encourage patients with cough to avoid lying on their back because this makes coughing ineffective. Older patients or those with impaired immunity or reduced ability to cough or clear secretions are more likely to develop severe pneumonia which could lead to respiratory failure or even death.

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